Biopsy-Proven Spontaneous Regression of a Rhabdomyomatous Mesenchymal Hamartoma

Authors

  • Joni M. Mazza M.D.,

    Corresponding author
    1. Department of Dermatology, St. Luke's-Roosevelt Center of the Icahn School of Medicine at Mount Sinai, New York, New York
    2. Department of Dermatology, Beth Israel Medical Center, New York, New York
    • Address correspondence to Joni M. Mazza, M.D., Department of Dermatology, St. Luke's-Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 11C, New York, NY 10025 or e-mail: jmazza17@gmail.com.

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  • Erica Linnell M.D.,

    1. Department of Dermatology, St. Luke's-Roosevelt Center of the Icahn School of Medicine at Mount Sinai, New York, New York
    2. Department of Dermatology, Beth Israel Medical Center, New York, New York
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  • Henry J. Votava M.D.,

    1. Department of Dermatology, Beth Israel Medical Center, New York, New York
    2. Department of Pathology, Beth Israel Medical Center, New York, New York
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  • Jeffrey H. Wisoff M.D.,

    1. Division of Pediatric Neurosurgery, New York University Medical School, New York, New York
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  • Nanette B. Silverberg M.D.

    1. Department of Dermatology, St. Luke's-Roosevelt Center of the Icahn School of Medicine at Mount Sinai, New York, New York
    2. Department of Dermatology, Beth Israel Medical Center, New York, New York
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Abstract

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare, benign, congenital tumor of the dermis and subcutaneous tissue comprised of skeletal muscle and adipose and adnexal elements. Although the majority of cases are an incidental finding in otherwise healthy patients, some have been reported in association with other anomalies. We present a full-term boy evaluated on day 2 of life for two lesions located on the midline of the lower back and right buttock that each appeared clinically as an atrophic, pink plaque. Ultrasound of the midline lesion revealed an underlying lipomyelomeningocele with a tethered cord in the spinal canal. Histopathology of the right buttock cutaneous lesion was consistent with a diagnosis of RMH. Surgical excision was performed on the midline intradural lipoma and the lesion on the buttock was monitored clinically. Repeat biopsy of this site at 1 year of age revealed complete spontaneous regression. This case highlights three interesting features: the association with an occult spinal dysraphism lipomyelomeningocele and tethered cord, the clinical presentation of an atrophic plaque as opposed to the more commonly reported raised lesions, and the phenomenon of spontaneous regression of the lesion. Most importantly, this final feature of regression in our patient suggests that, in the absence of symptoms, clinical observation of RMH lesions is warranted for spontaneous regression for 1 to 2 years provided that no functional deficit is noted and that the cutaneous or deeper lesions are not causing a medical problem.

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